Psychiatric Rehabilitation: Our Services in NYC area and Catskills

It is the most difficult decision you have ever been asked to make. Your loved one has a mental illness.  Outpatient counseling and psychiatry do not seem to be enough and out of home placement is being recommended. The term is Community Residence where they offer Psychiatric Rehabilitation.

 

WHAT IS PSYCHIATRIC REHABILITATION?

The Board of Directors of the United States Psychiatric Rehabilitation Association USPRA approved and adopted the following standard definition of psychiatric rehabilitation: Psychiatric rehabilitation promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. Psychiatric rehabilitation services are collaborative, person directed and individualized. These services are an essential element of the health care and human services spectrum, and should be evidence-based. They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning, and social environments of their choice.

WHAT WE OFFER

1.   4, 6 or 8 hours a week (divided into an average of 3 days a week) of “in-home” psychiatric rehabilitation services by licensed mental health professionals
2.  24 hour on-call emergency telephone support
3.  Individual psychotherapy and psycho-education
4.  Family therapy and psycho-education
5.  Individualized treatment planning
6.  Coordination with other service providers

Ø  Personal skill building in areas such as:

• Symptom Management
• Activities of Daily Living (ADL’S)
• Social Skills 
•  Budgeting
•  Shopping
•  Laundry
•  Cooking
•  Cleaning
•  Medication Management
•  Vocation and Education

Personal skills, also called “services” in Community Residences (Group Homes) are usually taught by nonprofessionals. We have Licensed Mental Health Professionals (Master Degree or above) working with your loved ones. 

WHY WE OFFER THIS SERVICE

1.      Psychiatric illness does not discriminate between the poor and the wealthy. It knows no class boundaries, racial divisions or sexual orientation. Psychiatric illness does not belong to any religious group or occupation. Psychiatric illness can hit anyone, anywhere no matter what his/her situation.

2.      For those who have pervasive, serious mental illness there are resources that can help. Private therapy and psychiatry, clinics, long term and acute hospitalization, day treatment, partial hospitalization, psychosocial clubs, community residences, and supported housing are among the traditional venues to treat these individuals. These resources have become fewer as resources become more scarce. Access to community based programs are regulated by the states and criteria for access to the most intensive of the community based programs, community residences, have been prioritized by current levels of care versus need.

3.      In New York State, the Office of Mental Health implemented a tier approach to individual’s admission to community residences under their umbrella. First to be accepted are those currently in state psychiatric hospitals. Second, are those currently in acute psychiatric hospitals. Third, are those who are homeless. Last, are those living in their own homes or with family.

4.      Community residences and supported housing apartments are generally located in areas of a community that are not always favorable: Low income and high crime rate neighborhoods where rents are low (to help agencies with operating costs) is the general norm.  Those based in other neighborhoods are generally far from family and the community that the ill person is comfortable with. This only compounds the problem for all involved. Those from prosperous communities must move away from their support systems which more than not compounds and even worsens their condition.

5.      What is needed is intensive psychiatric rehabilitation services delivered in their home, utilizing community services only as required. Why is this service needed?

A.      Access to care is limited based on the OMH tier approach described above.

B.      Most psychiatric rehab residences are located away from where the person       lives.

C.      The patient and his/her family may not want the patient to move away and leave home.

D.      There is greater anonymity.

E.      Flexibility: We do whatever will get results. We are not bound by agency protocols.

F.      Independent living or greater independence is the ultimate goal.

G.     Family involved weekly.

H.    Our services are individualized. We are dedicated to work with you and your loved one as long as the service is needed. Very specific goals and objectives are constructed with your loved one and family (with his/her permission) and an action plan are developed to meet these milestones.

THE PROCESS

1.       Contact us to schedule a private and confidential interview in your home.

2.       Choose from one of our 3 levels of care (All levels have the same services; the number of hours per week of the licensed mental health professional changes based on the level most suited for your loved one)

3.       Fill out our service agreement

4.       A licensed mental health professional will be chosen who can best meet the unique needs of your loved one and family

Contact Michael Raskind, LCSW michaelraskind@gmail.com

The Forgotten

It amazes me how people can start off as babies, get married, have children and end up alone and disabled in apartments or adult homes. I see people in psychotherapy in their homes and many of them are elderly. A portion of these holy spirits have wonderful support from their children and other family members. However, too many are alone, with inadequate home health aids, who spend more time on the phone with their friends than doing their jobs. The result is loneliness, physical illness and at times, extreme mental illnesses and other impairments that serve to break the heart of the toughest individuals. 

There are thousands of such people in New York City and millions in the world. They are the Forgotten. But, you can make a difference. If you would visit just one such person, and get your friends and coworkers to find someone to visit, then we as a people can reverse this sick trend and make the Forgotten, the Remembered! 

What is scary is this could be you someday.  

Three Types of Behavior: Myth or Fact?

Three Types of Behavior: Myth or Fact:

People in general, and especially children, thrive on attention. Children will bide for attention even if the attention they are getting is negative and disapproving. This is a fact that all people who deal with kids will hold as an absolute truth. In fact, kids who try to avoid attracting attention, generally are actually begging for someone to notice them. 

Getting attention, is directly connected to the responses we elicit through our behavior. Lets discuss what types of behaviors there are so we can better understand why children behave and misbehave because of their desire to get attention.

People categorize behavior into three categories: Positive, Negative, and "suppose to." Positive behavior is when your child does something that has positive outcomes, fits into social expectations, and follow the rules and expectations that their parents, teachers, etc have for them. Negative behavior is seen as doing something that is harmful to ones self, someone else, or someone's property, and is against the desires of what is expected from the child's authority figure(s). Suppose to behavior is a category in between. It is not seen as being either positive or negative, a sort of "neutral zone" for all you Trekkies out there. Problem is, its a myth!

When a child does what he is "suppose to" he is actually being good. For example, sleeping is generally seen as a neutral behavior. However, put it in a social context: in bed at night, or in class during school. Now it is no longer neutral.  He or she is having a positive or negative day depending on the context. The problem lies in how they get attention and for what behavior. 

It has been scientifically proven that people respond better to getting positives, than negatives. So at work, one may take on additional projects if told how much their efforts are appreciated than if one is criticized for being 5 minutes late. Children respond in the same way.  The following experiment should be done by all parents, even if their children behave well most of the time.

Find a day when you will be home with your child most of the day. Take a large pad of paper and list every behavior your child does from the moment they wake to after they go to bed.For example woke up, went to bathroom, flushed, washed hands, dried hands, brushed teeth... get it? At the end of the day, after you have used up several pens and two reams of paper, put a + or - sign next to each item. Remember, there are no neutral behaviors. Parents with the most horrific acting out children have found that there are always more positive behaviors than negative ones. Now, the hard part: Of all these behaviors, which ones did you react to, giving some kind of feedback or response to your child? And if you could give each response a "weight" (level of intensity of your response), which behaviors  received the most responses and the most intensity? Most parents who do this exercise, state that they gave the negative behaviors the most attention both in numbers and in intensity.

Let's go back to our discussion earlier, children want attention, they thrive on it. If they get the most attention, and the most intense attention, from the negative behaviors, it follows that they will misbehave more than behave so that they are assured the attention they crave.  In fact, for those who have children whose behavior has declined overtime, it may very well be because the negatives give them more attention. 

The immediate solution for parents is to provide more attention to those behaviors given a positive sign and no attention, if possible,to as many of the behaviors that have negative signs. After awhile, your child will begin focusing less on getting attention negatively.

For more information on this subject, reference Instruction Manual for Your Child 

Do Parents with Mental and Emotional Issues Have Rights?

WARNING: What follows will have the tendency to anger the reader and may induce a strong desire to become politically active to combat governmental abuse of families.

Do parents with developmental disabilities, or emotional problems, or psychiatric disorders have the right to have and raise children? More, do we as a society have the duty to provide supports, wherever necessary, to help parents with these conditions be successful? Based on the following true story, the answer from the New Jersey Department of Youth and Family Services is a resounding  NO!

I recently became acquainted with a young couple through my place of worship. Though I am a Licensed Clinical Social Worker and have worked with families my entire career, there was nothing I could do but provide support as a member of the congregation; because the process had already gone too far.

Mrs. A had been brought up by parents, though loving, were micro managers and thus provided an atmosphere of "dysfunction" from which Mrs. A had developed strong tendencies toward depression and  bipolar symptoms. She met her husband and married. She became pregnant and the couple was happy with the anticipation of a new addition to their family. 

Mr. A has a developmental disability called Asperger Syndrome, a type of autistic disorder where the person is quite functional but often appears socially odd; missing social ques. Often, these individuals are quite intelligent, as is the case of Mr. A. They hold jobs, get college educations, own homes...


Mrs. A is followed by a psychiatrist and is treated with medication successfully. Previously, she was seeing a psychotherapist, in her town, who recommended that she think about putting the baby up for adoption because it would be a difficult road raising the child. The couple had decided to keep the child and did take the advice of their former counselor (she had passed away) but, at the urging of the therapist they called the New Jersey Department of Youth and Family services, DYFS to ask for HELP!.  This is where the events become unbelievable!


As soon as Mrs. A delivered, DYFS placed the child in foster care! Never did they offer preventive services, supports such as: respite, parenting training, homemaker services; as is the routine with most families these types of agencies come into contact with. The mission of children services agencies is to keep families together, and if placement is necessary, to make all attempts to reunify the family. Since the child was born a few weeks early, they pressed "neglect" charges against Mr. A because he had not yet purchased all the equipment and supplies needed for a baby. Reality is that he had obtained much of what was needed but had not yet put them in the apartment, figuring he had a few weeks, and his wife and new born were in the hospital early. How can one neglect a child before it is born? 

A family was chosen from a town over an hour away from the couple, who wanted to adopt the child right away. According to the father's attorney, this town has a group of influential parents with fertility problems that seem to be able to get adoptive children from DYFS quite regularly. It is not known if this family was part of this group. But, it makes you wonder. 


Mrs. A became depressed, postpartum, and her depression increased as she saw her child leave the hospital, in the care of another couple who had intentions of keeping her daughter. DYFS pointed toward the depression as evidence, though it was their actions that pushed this young mother, already struggling with depression deeper into an abyss. 


The foster family had kept the child for 2 years with the young couple visiting weekly. Professionals from both sides, DYFS, and parents, did agree that there was not enough visitation. After 2 years of living and breathing this issue, the mother felt she no longer had the internal strength to fight the case. Her husband supported his wife, though he would have fought more. DYFS used this as evidence of the couple's inability to parent. What must be understood, is that the DYFS workers go home and do not think about this family or the little girl. To them its a job. The parents, who are dealing from a deficit position with emotional problems of their own, were exhausted. They eventually signed their parental rights away. 


One of the questions that the mother asked which brought on a bout of nausea in me was "will they ever allow us to have children?' I have worked with a tremendous amount of families in my 30 years as a professional, in much worse circumstances than the A's, and have been able to keep the families together with the proper supports in place and they became wonderful families raising wonderful children. It is clear, that DYFS, which is being observed by the federal government, due to colossal deficiencies in its services, misused its powers and committed tremendous injustices in this case: And how many others?


My response to Mrs. A's question was: "Have you ever thought of moving out of New Jersey?"  So, again, I ask: do parents with mental and emotional issues have the right to raise children? Not in the State of New Jersey.